Download calcium homeostasis

Endocrine Regulation of Calcium
and Phosphate Metabolism
Huiping Wang (王会平), PhD
Department of Physiology
Rm C516, Block C, Research Building, School of
Medicine
Tel: 88208252
Email: [email protected]
Outline
• Hormonal Regulation of [Ca2+]
– Action of PTH
– Action of vitamin D(1,25- (OH)2-D3)
– Action of calcitonin
Endocrine Regulation of Calcium
and Phosphate Metabolism
• Hormonal control:
– PTH, vitamin D(1,25- (OH)2-D3), calcitonin
• Major regulatory organs:
– intestine, bone, kidneys
Vitamin D
• Vitamin D, after its activation to
the hormone 1,25(OH)2D, is
one of the major regulators of Ca
& Pi metabolism
• Sources of vitamin D:
– produced in the skin by UV
radiation (D3)
– ingested in the diet (D3 rich in
fish, liver, milk)
Vitamin D is not a “classic hormone” because it is not produced by an
endocrine gland. However, its metabolite acts as a hormone by the
mechanism similar to that of thyroid and steroid hormones
Formation of Active Vitamin D
• Sunlight (290-315 nm) stimulates skin
cell to produce previtamin D3 which is
then converted to vitamin D3
• Over exposure to sunlight converts
previtamin D3 to inactive products
• Vitamin D has very little intrinsic
biological activity and must undergo
successive hydroxylations in order to
act as a hormone
• In liver, it is hydroxylated to 25-OH-D
which is transported to kidney to form
1,25-(OH)2-D or 24,25-(OH)2-D
• 1,25-(OH)2-D is the most potent
vitamin D metabolite
Actions of 1,25-(OH)2-D3
• Acts through nuclear receptors
• Intestine
– increases Ca absorption
– stimulates phosphate absorption
• Bone
– stimulates Ca and Pi resorption
– provides Ca and Pi from old bone to mineralize
new bone
• kidney
– Enhances Ca and Pi reabsorption of renal tubule
Rickets
• Deficiency of vitamin D causes
inadequate mineralization of new
bone matrix (lowered ratio of
mineral/organic matrix)
• Caused by deficiency of vitamin
D activity (dietary deficiency,
insufficient sun exposure,
liver/kidney diseases)
• Symptoms: decreased
mechanical strength and
distortion especially in the long
bones of legs.
Parathyroid Glands
• 4 glands located
behind the thyroid
• each gland weighs
30-50 mg
• main cell type:
– chief cells
• Parathyroid Hormone
Parathyroid Hormone (PTH)
• Polypeptide
PTH Actions
• Major target organs
– bone
•  Bone resorption by stimulating osteoclasts and osteocytes and
inhibiting osteoblasts
– kidney
• Reabsorption of Ca++ and excretion of phosphate
– intestinal tract (indirect effect)
• Absorption of calcium from the small intestine
• Overall effect
– increase plasma [Ca2+]
– decrease plasma [Pi]
Factors Affecting PTH Secretion
• Ca and PTH form a
negative feedback
pair
• 1,25-(OH)2-D and
PTH form negative
feedback loop
Hypocalcemia
damage to blood supply during thyroidectomy
Calcitonin
• Parafollicular or C cells
• Peptide
• Action
– Plasma [Ca2+]
• Bone
– by inhibiting osteoclasts
(for bone resorption) &
stimulating calcium uptake
by bones
– By inhibiting synthesis and
activity of osteoclasts
• Kidney
• Regulation: [Ca2+]
•
•
It plays no role in normal day-to-day regulation of plasma calcium regulation in humans
Calcitonin is used in
–
–
acute treatment of hypercalcemia
alternative of estrogen for treating osteoporosis in women
Hormonal Regulation of [Ca2+]
QUIZ
A patient with parathyroid deficiency 10 days after
inadvertent damage to the parathyroid glands during
thyroid surgery would probably have
A. low plasma phosphate and Ca2+ levels and tetany
B. low plasma phosphate and Ca2+ levels and tetanus
C. a low plasma Ca2+ level, increased muscular excitability, and a
characteristic spasm of the muscles of the upper extremity
(Trousseau’s sign)
D. high plasma phosphate and Ca2+ levels and bone demineralization
E. increased muscular excitability, a high plasma Ca2+ level, and bone
demineralization
QUIZ
A patient with parathyroid deficiency 10 days after
inadvertent damage to the parathyroid glands during
thyroid surgery would probably have
A. low plasma phosphate and Ca2+ levels and tetany
B. low plasma phosphate and Ca2+ levels and tetanus
C. a low plasma Ca2+ level, increased muscular excitability, and a
characteristic spasm of the muscles of the upper extremity
(Trousseau’s sign)
D. high plasma phosphate and Ca2+ levels and bone demineralization
E. increased muscular excitability, a high plasma Ca2+ level, and bone
demineralization
QUIZ
Which of the following is not involved in
regulating plasma Ca2+ levels?
A. Kidneys
B. Skin
C. Liver
D. Lungs
E. Intestine
QUIZ
Which of the following is not involved in
regulating plasma Ca2+ levels?
A. Kidneys
B. Skin
C. Liver
D. Lungs
E. Intestine
Summary
• Hormonal Regulation of [Ca2+]
– PTH: [Ca2+]
– Vitamin D(1,25- (OH)2-D3): [Ca2+]
– Calcitonin: [Ca2+]